Person-Centered Coordinated Care Experience of People With Long-Term Conditions in the Balearic Islands Measured by the P3CEQ.

Objective: This study aimed to use the Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) to assess the experience of person-centered coordinated care among people with long-term conditions in the Balearic Islands, Spain. Methods: Over 1300 participants receiving treatment for chronic conditions or HIV pre-exposure prophylaxis were invited to complete the P3CEQ and a socio-demographic questionnaire, both administered electronically via the Naveta app. The P3CEQ assesses the key domains of the P3C through an 11-item questionnaire. Items 1, 2, 3, 4, 5, 8, 9 and 10 assess specifically person-centredness (PC subscale), while items 5, 6, 7, 8 and 9 measure care coordination (CC subscale; question 7 includes 4 sub-questions to specifically assess care plans). Descriptive statistics were used to summarize patient characteristics and P3CEQ items scores. Data analysis included chi-squared test of independence, Student's t-test and analysis of variance test. Pairwise comparisons were adjusted by Bonferroni correction. Results: The P3CEQ and a socio-demographic questionnaire were sent to 1313 individuals (651 men, 657 women, 5 'other gender'). A response rate of 35.34% was achieved, with 464 P3CEQ responders (223 men and 241 women). Significant differences in response rates were observed by age, smoking status, alcohol consumption, membership of patient organizations, and use of alternative medicine. Care planning was rated significantly lower than other measured domains. Women experienced less person-centered care than men (16.64 vs 17.91) and rated care coordination worse than their male counterparts (9.18 vs 10.23). There were also differences in scores between medical condition types, with cancer and inflammatory bowel disease patients rating highest for both person-centered care (21.20 and 19.13, respectively) and care coordination (10.70 vs 10.88, respectively). Patients with skin and rheumatic diseases rated lowest their experience of person-centered care. People with higher education and those employed or studying experienced better person-centeredness. Conclusion: Using the P3CEQ, we detected significant differences in the care experiences of people with chronic conditions, suggesting the need to address potential gender biases, social inequalities, and the poorer ratings observed for certain conditions in the study population.

Implementing Systematic Patient-Reported Measures for Chronic Conditions Through the Naveta Value-Based Telemedicine Initiative: Observational Retrospective Multicenter Study.

BACKGROUND: Patient-reported outcome and experience measures can play a critical role in providing patient-centered and value-based health care to a growing population of patients who are chronically ill. Value-based telemedicine platforms such as the Naveta initiative may facilitate the effective integration of these tools into health care systems. OBJECTIVE: This study aims to evaluate the response rate to electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures (ePREMs) among patients participating in the Naveta telemedicine initiative and its correlations with sociodemographic and clinical characteristics, as well as the evolution of the response rates over time. METHODS: Between January 1, 2021, and June 30, 2023, a total of 53,364 ePREMs and ePROMs for 20 chronic conditions were administered through the Naveta-Phemium platform. Descriptive statistics were used to summarize continuous and categorical variables. Differences in response rates within each sociodemographic variable were analyzed using logistic regression models, with significance assessed via chi-square and post hoc Tukey tests. Two-way ANOVA was used to examine the interaction between time interval and disease type on response rate evolution. RESULTS: A total of 3372 patients with severe chronic diseases from 64 public hospitals in Spain participated in the Naveta health questionnaire project. The overall response rate to ePROMs and ePREMs during the first 2.5 years of the Naveta initiative was 46.12% (24,704/53,364), with a baseline rate of 53.33% (7198/13,496). Several sociodemographic factors correlated with lower response rates, including male gender, older age, lower education level, frequent alcohol use, being a student, and not being physically active. There were also significant variations in response rates among different types of chronic conditions (P<.001), with the highest rates being for respiratory (433/606, 71.5%), oncologic (200/319, 62.7%), digestive (2247/3601, 62.4%), and rheumatic diseases (7506/12,982, 57.82%) and the lowest being for HIV infection (7473/22,695, 32.93%). During the first 6 months of follow-up, the response rates decreased in all disease types, except in the case of the group of patients with oncologic disease, among whom the response rate increased up to 100% (6/6). Subsequently, the overall response rate approached baseline levels. CONCLUSIONS: Recognizing the influence of sociodemographic factors on response rates is critical to identifying barriers to participation in telemonitoring programs and ensuring inclusiveness in patient-centered health care practices. The observed decline in response rates at follow-up may be due to survey fatigue, highlighting the need for strategies to mitigate this effect. In addition, the variation in response rates across chronic conditions emphasizes the importance of tailoring telemonitoring approaches to specific patient populations.

Cost-effectiveness of olaparib plus bevacizumab versus bevacizumab monotherapy in the maintenance of patients with homologous recombination deficiency-positive advanced ovarian cancer after response to first-line platinum-based chemotherapy.

OBJECTIVE: The PAOLA-1 trial confirmed that adding olaparib to bevacizumab significantly increased clinical benefit following response to platinum-based chemotherapy in homologous recombination deficiency-positive ovarian cancer. The objective of this analysis was to determine the cost-effectiveness of olaparib plus bevacizumab compared with bevacizumab alone as maintenance treatment for patients with homologous recombination deficiency-positive advanced ovarian cancer from the Spanish National Health System perspective. METHODS: A lifetime partitioned survival model with four health states (progression-free, post-progression 1, post-progression 2, and death) and monthly cycles was developed. Long-term survival, defined as 60 months, was included as a landmark to extrapolate progression-free survival from PAOLA-1. Weibull distribution was selected as the most accurate survival model for progression-free survival extrapolation. Time to second progression and overall survival were extrapolated using parametric survival models. Mortality was obtained from the overall survival and adjusted by Spanish women mortality rates. Health state utilities and utility decrements for adverse events were included. An expert panel validated data and assumptions. Direct costs (in 2021 euros (€)) were obtained from local sources and included drug acquisition and administration, subsequent therapies, monitoring costs, adverse events, and palliative care. A 3% annual discount rate was applied to costs and outcomes. The incremental cost-effectiveness ratio was calculated as cost per quality-adjusted life-years (QALYs) gained. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Compared with bevacizumab alone, olaparib plus bevacizumab increased QALYs and life-years by 2.39 and 2.77, respectively, at an incremental cost of €58 295.31, resulting in an incremental cost-effectiveness ratio of €24 371/QALY. Probabilistic sensitivity analysis demonstrated that olaparib plus bevacizumab had a 49.5% and 90.3% probability of being cost-effective versus bevacizumab alone at a willingness-to-pay threshold of €25 000 and €60 000 per QALY gained, respectively. CONCLUSION: For patients with homologous recombination deficiency-positive advanced ovarian cancer, olaparib plus bevacizumab is a cost-effective maintenance therapy compared with bevacizumab alone in Spain.

Seguimiento del primer año de tratamiento antirretroviral en pacientes naive en un hospital de tercer nivel / First year monitoring of antiretroviral therapy in naïve patients in a tertiary hospital

Objetivo: El objetivo principal de este trabajo es determinar la tasa de fracaso virológico (FV) en pacientes naive que inician tratamiento antirretroviral (TAR) a 24 y 48 semanas en vida real en un hospital de tercer nivel. Material y método: Estudio retrospectivo de 3 años de duración. Se seleccionaron pacientes adultos VIH naive que iniciaron TAR entre 2012 y 2014. Se registraron datos demográficos (edad, sexo y nacionalidad), clínicos (mecanismo de trasmisión y estadio clínico), de laboratorio (carga viral (CV), linfocitos CD4 basales y existencia de test de mutaciones previo) y TAR elegido. Tras 24 y 48 semanas se registraron: CV y CD4, adherencia, seguimiento, problemas relacionados con la medicación, cambios de TAR y motivos de cambio. Resultados: Se seleccionaron 253 pacientes. 244 y 226 contaban con datos analíticos a las 24 y 48 semanas respectivamente. 142 (58,23%) tenían CV<50 copias/ml y 204 (83,6%) CV<200 copias/ml tras 24 semanas. 198 (88,4%) tenían CV<50 copias/ml y 217 (96,0%) CV<200 copias/ml tras 48. La CV basal superior a 100.000 copias/ml y la mala adherencia se asociaron con un mayor riesgo de FV. Al 30,0% de pacientes se les cambió el TAR durante el primer año, principalmente por efectos secundarios (31,6%) y simplificación del tratamiento (23,7%). Discusión y Conclusiones: Un alto porcentaje de pacientes que inician TAR están indetectables o con menos de 200 copias/ml dentro del primer año de tratamiento. A pesar de tener fármacos altamente eficaces y cada vez mejor tolerados, los efectos secundarios siguen siendo el motivo mayoritario de cambio de TAR.

Background and objective: The main objective of this work is to determine the rate of virologic failure (VF) intreatment-naïve patients, 24 and 48 weeks after starting antiretroviral therapy (ART) in real life in a tertiary hospital. Patients and Methods: A retrospective study of 3 years duration. Naïve HIV adult patients who started ART between 2012 and 2014 were selected. Demographics (age, sex and nationality), clinical (transmission mechanism and clinical stage), laboratory (viral load (VL), baseline CD4 and existence of prior mutations test) and TAR chosen were recorded. VL and CD4, adherence, monitoring, medication-related problems, changes and reasons for changing ART were registered at 24 and 48 weeks. Results: Of 253 patients selected, analytical data was available for 244 and 226 at 24 and 48 weeks, respectively. After 24 weeks, VL was <50 copies/ml in 142 (58.23%) patients and <200 copies/ml in 204 (83.6%). After 48 weeks, the same values were 198 (88.4%) and 217 (96.0%), respectively. Baseline VL above 100,000 copies/ml and poor adhesion to treatment were associated with an increased risk of VF. Thirty per cent of patients switched ART during the first year, mainly because of side effects (31.6%) and simplification of treatment (23.7%). Conclusions: VL became undetectable or under 200 copies/ml in a high percentage of patients starting ART within the first year of treatment. Despite the increasingeffectiveness and tolerability of available drugs, side effects remain as the major reason for changing ART.

Targeting DNA with small molecules: a comparative study of a library of azonia aromatic chromophores.

A library of azonia aromatic cations has been studied in order to gain insights into the effect of the size, shape and charge distribution on the fluorescence, DNA interactions and DNA sequence selectivity properties. Fluorescence-based thermal denaturation experiments, spectrofluorimetric titrations, circular dichroism measurements and theoretical simulations have shown that some of the studied chromophores have interesting fluorescence properties and two of them also show a consistent DNA-binding ability by intercalation, with a potential preference for AT-rich sequences.

Preparation of layered double hydroxide/chlorophyll a hybrid nano-antennae: a key step.

In the first step to obtain an efficient nano-antenna in a bottom-up approach, new hybrid materials were synthesized using a set of layered double hydroxides (LDHs) with basic properties and pure chlorophyll a (Chl a). The stability of the adsorbed monolayer of Chl a was shown to be dependent on the nature and the ratio of the different metal ions present in the LDHs tested. The hybrid materials turned out to be adequate for stabilizing Chl a on Mg/Al LDHs for more than a month under ambient conditions while a limited catalytic decomposition was observed for the Ni/Al LDHs leading to the formation of pheophytin. These changes were followed by namely XRD, DR-UV-vis and fluorescence spectroscopies of the hybrid antennae and of the solutions obtained from their lixiviation with acetone or diethylether. On Mg/Al hydrotalcites the stability of the adsorbed Chl a was equivalent for values of the metal atom ratio ranging from 2 to 4. The latter hybrids should constitute a good basis to form efficient nanoscale light harvesting units following intercalation of selected dyes. This work describes an efficient preparation of Chl a that allows scale-up as well as the obtention of a stable Chl a monolayer on the surface of various LDHs.

Twofold role of calcined hydrotalcites in the degradation of methyl parathion pesticide.

Methyl parathion (MP) is a very toxic organophosphate pesticide used as a non-systematic insecticide and acaricide on many corps. As MP and its by-products are highly toxic, they have to be retained to avoid pollution of rivers and lakes. Highly efficient sorbents are hydrotalcites (HTs) (or anionic clays). We have correlated the degradation of an aqueous solution of MP at room temperature, with the basicity of the adsorbing materials. It was found that the metal composition of hydrotalcites determines both the surface electronic properties (basic or acidic) and the sorption capacity. Depending on the basic strength, some calcined hydrotalcites can catalyze the transformation of MP to p-nitrophenol (p-NP) and retain its by-products. Such a process has the advantage of being able to be carried out at room temperature and at the pH of the pesticide solution.

Cesium leaching from gamma-irradiated CsA and CsX zeolites.

The present study discusses the effect of gamma-irradiation on Cs+-exchanged X and A zeolites. The incorporation of Cs+ ions into A and X zeolites was performed using three different cesium salts (chloride, nitrate or acetate). Cs+ ions immobilized into the vitrified zeolites by thermal treatment are located in different sites of the zeolite networks. It is found that gamma-irradiation favors cesium retention depending on the cesium precursor salt used in the cationic exchange step.

Immobilization of cobalt in collapsed non-irradiated and gamma-irradiated X zeolites.

Cobalt exchanged X zeolites were gamma irradiated and heated until the zeolite structure collapsed. Heating destroys the zeolite network as found by X-ray-diffraction and 29Si, 27Al MAS NMR spectroscopy. Gamma irradiation treatment diminished the collapsing temperature of zeolite. Cobalt leaching from crystalline and amorphized zeolites was verified by ion exchange with NaCl solution. Results show that cobalt is not released from the amorphous materials. Furthermore adsorption of xenon and 129Xe NMR spectroscopy reveal that cobalt ions are heterogeneously distributed in the non irradiated amorphous materials. Gamma irradiation causes the mobility of cobalt in the amorphous materials resulting then in a more homogeneous distribution. Cobalt is, thus, retained safely in the amorphous materials.

II. Cesium leaching in CsA and CsX zeolites: use of blocking agents to inhibit the cesium cation mobility.

Cesium-exchanged A and X zeolites were loaded with cesium acetate species and thermally treated in order to inhibit the mobility of exchangeable cesium cations. The proposed procedure seems to block the cavities channels avoiding the releasing of cesium cations under the leaching conditions. The cesium impregnated species did not induce strong structural modifications if they are used in small amounts (0.2 meq/g zeolite), but they promote transformation toward cesium orthosilicate if they are loaded in amounts as high as 2 meq/g zeolite. This orthosilicate retains safely the cesium as it is a component of the lattice.

Characterization of enamel with variable caries risk.

Small angle X-ray scattering (SAXS), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR) have been used to look at enamel from nine premolars, three each from individuals in low, medium and high risk caries groups. Only SAXS was able to detect consistent differences between any of the groups. In enamel from the high caries risk group, the micropores between the hydroxyapatite crystals were laminar. In enamel from the low caries risk group, the micropores were cylindrical. Other parameters varied between teeth but were not correlated with caries risk.

Passivation of the calcite surface with phenylmalonate and benzylmalonate ions.

We explored the affinity of calcite to adsorbed organic molecules as an approach to the conservation of cultural heritage built of marble and limestone. The utilization of phenylmalonic and benzylmalonic acids provided a hydrophobic adsorptive interface, adequate to prevent processes of aqueous weathering. Samples of marble powder (polycrystalline calcite) were impregnated with solutions of phenylmalonic and benzylmalonic acid at three concentrations (5 x 10(-2), 5 x 10(-3), and 5 x 10(-4) M) and different pH values (6.00, 7.00, and 8.00). The surface charge of the calcite suspensions was determined by potentiometric measurements under equilibrium conditions at room temperature in aqueous solution of the dicarboxylic acids, in order to understand the influence of the electrokinetic potential in the surface association. The adsorbed amounts were determined by calculation of the thermodynamic equilibria of solutions. The presence of the organic interface on the mineral surface was corroborated by Raman spectroscopy and small-angle X-ray scattering (SAXS). The results indicate effective adsorption of both dicarboxylic acids as a function of the concentration and pH, and several other conditions that favors coulombic interaction, an absence of electrophoretic mobility or surface electroneutrality related to the solid surface potentials. The coverage of pores by dicarboxylic adsorbate modified the geometrical pore shape and the pore size distribution, filling all the pores of larger than 80 A diameter, giving as a result a mesoporous structure. This change in the surface morphology by organic adsorbates constitutes a modification in the diffusional processes of the environment on the mineral surface.

Structural evolution of phosphated alumina during sol-gel synthesis.

Phosphated alumina gels were prepared by the sol-gel method. Gels were aged from 1 to 8 days in air. Gel structure evolution, as time went on, was followed by 27Al magic angle spinning nuclear magnetic resonance, X-ray diffraction, and small-angle X-ray scattering. It is concluded that the aging time is a crucial parameter in the formation of coordinately unsaturated sites of aluminum (AlIV and AlV). The gel network is shown to have a fractal structure.

Passivation of the calcite surface with malonate ion.

Samples of polycrystalline calcite were impregnated with solutions of malonic acid of three concentrations (5 x 10(-2), 5 x 10(-3) , and 5 x 10(-4) M) and different pH values (6.00, 7.00, and 8.00). The impregnation was carried out at room temperature to evaluate the adsorption of malonate ion in the calcite surface to optimize the conditions for possible application on limestone and marble in cultural heritage materials. The affinity of the malonate ion was determined through the potentiometric measurement of the surface charge and the corresponding adsorbed amounts by titration, Raman spectroscopy, and small-angle X-ray scattering (SAXS). The results indicate effective adsorption of the malonate ion on the surface at a pH value close to the point of zero charge (pHpzc approximately 8.20) and changes in some surface morphological properties such as the pore shape and the pore size distribution. The presence of a malonate adsorptive layer on calcite generates an interface interaction potential that may influence the reaction and transport mechanisms within the medium.